Native-Centered Nutrition Education · • “End of the wagon era” • Personal communication with Lakota, Johnson Holy Rock • 1960s: • “Ring Bologna and a Loaf of White”

Native-Centered Nutrition EducationSee, Touch, and Taste Your Way to Learning Nutrition

Kibbe Conti, MS, RDN

Consult a Registered Dietitian Nutritionist (RDN)

• For personalized nutrition advice, consulta registered dietitian nutritionist (RDN).

• You can ask your doctor for a referral toan RDN or meet with RDNs in a variety ofsettings throughout your community.

• Find an RDN who is specialized to serveyour unique needs. RDNs provide sound,easy-to-follow personalized nutritionadvice to meet your lifestyle, preferences,and health-related needs.

• To find an expert in your area, visit theAcademy of Nutrition and Dieteticswebsite at https://www.eatright.org/.

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Heritage Foodways as a Food Guideline

Evolving Foodways• We all come from a people who utilized the plants and animals

to support human health of a nation.

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Traditional FoodsCultural Connections• “As indigenous people, we draw our resilience and

strengths from our ancestral knowledge, culturaltraditions, languages and our connections to land,water and all living things.”

• NB3 Foundation:http://www.nb3foundation.org/our-approach/cultural-connections/

• Our indigenous cultures are the foundation to howwe live our lives

• Complimentary materials at the GPGHW website:https://health.gptchb.org/gpghw/ssb/

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Original American Foods

• It is said that 70% of the worldscultivated crops today are fromfoods that originated in theAmericas and were developedby the Indians.

• These crops were a greatcontribution to the nations acrossthe Old World. This is just apartial listing of important foodcrops that originated in theAmericas.

• Corn

• Bean Varieties

• Potato

• Sunflowers

• Avocado

• Squash

• Chili Peppers

• Coffee

• Tomato

• Cocoa

• Strawberry

• Pumpkin

• Pineapple

• Peanuts

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Buffalo Bird Woman, Hidatsa

“We cared for our corn in those days as we would care for a child; for we Indian people loved our gardens, just as a mother loves her children; and we thought that our growing corn liked to hear us sing, just as children like to hear their mothers sing to them.”

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Corn• Increased the supply of meat and lard, also eggs, milk, butter, cheese, and all animal

products

• Population Impact in Europe from 1650 to 1950

• 100 million to 600 million

• Food system plagued by famines

• Europe's richest country France suffered from a total of 111 famines from 1371 to 1791.

• Frequent famines ended with the introduction/production of corn, potato, peanut,sunflower, beans etc.

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Slow Foods

Absorption keeps pace with insulin production

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Introduction of European Food and Government Rations

• Beef, pork, poultry, dairy, fruit, flour – fry bread, refined wheat bread, salt pork, coffee• Despite major changes, the people still hunted small and gathered plants and were still

relatively a healthy nation.

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Modern Refined Foods and Diabetes

“It is widely recognized that the replacement of indigenous foods with a diet composed primarily of modern refined foods is the center piece of the diabetes problem.”• Kuhnlin, HV. “Culture and Ecology in Dietetics and Nutrition.” Journal of the American

Dietetic Assoc. 1989, 89 (8) 1059–1060.

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Loss of the Bottomlands

• Mandan/Hidatsa/Arikara Nation• Loss of 98% of agricultural lands

• When tribes negotiated treaties, they werethinking of traditional foods, not commodities

• Hunting and gather places were made offlimits

• Agricultural became difficult or impossible• Traveling was prohibited and trade all but

stopped• The culture and economy changed

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Loss of the Traditional Land Base

• Fishing, hunting, and gathering places weremade off limits

• Agricultural became difficult or impossible• Traveling was prohibited and trade all but

stopped• Depleted salmon runs• Loss of pure water source• Depletion of starchy roots and bulbs• The culture and economy changed…

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Timeline of the Emerging Epidemic

• 1950s:• “End of the wagon era”

• Personal communication with Lakota, Johnson Holy Rock

• 1960s:• “Ring Bologna and a Loaf of White”

• First experience Soda beverage

• 1970s:• Epidemic of Diabetes emerges in Northern Plains.

• 1980s:• Declared an Epidemic by Fed/CDC

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Native Adults Have More Diabetes Than Other Race or Ethnicity• Diabetes emerged in the 1960s and 70s. In the Northern Plains,

it was finally declared an epidemic in the early 80s. Rates varywidely.

• Woolf et al. (2015) found that nearly 23% of adults with incomesbelow $35,000 reported being in poor and fair health, comparedwith 13% of adults with incomes between $35,000 and $49,999,and only 6% of adults with incomes of $100,000 or more.

• Woolf et al. (2015) also found that prevalence rates for a rangeof health problems, including diabetes, coronary heart disease,stroke, and kidney disease, are highest for low-income adultsand decrease with income level.

• Kidney failure from diabetes among Native Americans was thehighest of any race. However, this has declined the fastest sincethe Indian Health Service (IHS) began using population healthand team-based approaches to diabetes and kidney care, apotential model for other populations. Health care systems canuse population health approaches to diabetes care. 14

Unci’s Soup vs. Ramen• Bone broth, meat, starchy vegetable vs. enriched wheat, salt, fat

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Traditional Learning

• Intergenerational learning• Learning actively, naturally• Story telling, observing, under guidance of elder/mentor• See, touch, taste

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How Insulin Works• When you eat or drink things that have carbohydrates, your body breaks those carbs down into

glucose (a type of sugar), which then raises the level of glucose in your blood. Your body uses thatglucose, or sugar, for fuel to keep you going throughout the day.

• Knowing what kind and how many carbs to eat is important for managing diabetes. Eating too manycarbs can raise your blood glucose too high.

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Case StudyJulia• 51-year-old Zuni female. BMI: 41, Weight: 217• c/o 25 lbs. weight gain in 2 years, Non-diabetic, Family Hx: DM2• Feeling too tired to do yardwork more than 5 minutes and sleeping often• Using a walker due to weakness.• Pertinent Labs: Alb 3.0, K+ 3.3 L, Chol 189, Trig. 313, A1C 5.5• Diet recall:

• 11 a.m.: Fried Potatoes w chilis, Fry Bread, Pepsi

• 4 p.m.: Hamburger on a bun, can of soda, fries

• 6 p.m.: Snack: cookies or pudding

• 9 or 10 p.m.: Snack — Potato chips, Cheez-its, or ramen; water

Patient denies any knowledge of carbs. No nutrition education with a dietitian. 18

Adult Energy Needshttps://www.eatright.org/

WomenAge

Sedentary Moderately Active Active

19–30 1,800–2,000 2,000–2,200 2,400

31–50 1,800 2,000 2,200

51+ 1,600 1,800 2,000–2,200

MenAge

Sedentary Moderately Active Active

19–30 2,400–2,600 2,600–2,800 3,000

31–50 2,200–2,600 2,400–2,600 2,800–3,000

51+ 2,000–2,200 2,200–2,400 2,400–2,800

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Eat Less of These

• Refined, highly processed carbohydrate foodsand those with added sugar

• Sugary drinks like soda, sweet tea, and juicedrinks

• Refined grains like white bread, white rice,and sugary cereal

• Sweets and snack foods like cake, cookies,candy, and chips

• https://www.choosemyplate.gov/

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Grains• There are three main types of carbohydrates in food—starches, sugar and fiber.• As you’ll see on the nutrition labels for the food you buy, the term “total carbohydrate” refers

to all three of these types.• As you begin counting carbohydrates, you’ll want to stay away from food that has high

carbs and instead choose a more balanced nutrient mix of carbs, protein, and fat.

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Eat More Whole Grains• Whole grains provide dietary fiber, as well as a variety of antioxidants, vitamins, and

minerals.• Serve brown rice or whole-grain noodles with stir-fry dishes.• Choose whole-grain breads for toast or sandwiches.• Use buckwheat flour in pancakes.• Pair whole-grain hot or cold cereals with fruit and low-fat milk.• Try a less common grain, such as millet or quinoa with meals.• Another simple tip is to make at least half of the grains you eat daily whole grains.• Examples of whole grains include whole wheat bread, brown rice, and oatmeal, as

well as less-common grains, such as millet, quinoa, and bulgur.• For more information, visit https://www.choosemyplate.gov/.

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Starchy Vegetables

• Corn, green peas, sweet potatoes, pumpkin, plantain,beans and lentils (like black beans, kidney beans,chickpeas, and green lentils)

• The goal is to choose carbs that are nutrient-dense, whichmeans they are rich in fiber, vitamins, and minerals, andlow in added sugars, sodium, and unhealthy fats.

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2015-2020 Dietary Guidelines for Americans: Table A4-1 Healthy Mediterranean-Style Eating Pattern: Recommended Amounts of Food From Each Food Group at 12 Calorie Levels

“The Healthy Mediterranean-Style Pattern is adapted from the Healthy U.S.-Style Pattern, modifying amounts recommended from some food groups to more closely reflect eating patterns that have been associated with positive health outcomes in studies of Mediterranean-Style diets.”https://health.gov/sites/default/files/2019-09/2015-2020_Dietary_Guidelines.pdf

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Nutrition Facts LabelsThe new Nutrition Facts labels make it easier to make healthful choices.

• Updated serving sizes to reflect what people actually eat anddrink.

• Bolder, larger fonts for the number of calories.

• A new line for Added Sugars, which is now required on thelabel. (Although single-ingredient sugars, like table sugar,maple syrup, or honey will only reflect a percent DailyValue.)

• An updated list of vitamins:

• Vitamin D and potassium are now required on the label;vitamins A and C are no longer required.

The amount recommended for some of the nutrients have also changed recently, and the labels will reflect these new amounts.Source: U.S. Food and Drug Administration. Health Educator’s Nutrition Toolkit: Setting the Table for Healthful Eating. Available at: https://www.fda.gov/food/nutrition-education-resources-materials/health-educators-nutrition-toolkit-setting-table-healthy-eating 25

More Ideas for My Native Plate

• Eating healthy requires a balanced mix of keynutrients (protein, fat, carbohydrates, fiber,vitamins, and minerals) to sustain a healthybody and mind. It also requires anenvironment that promotes access to healthy,local and affordable foods and safe drinkingwater.

• For Native families and communities, thisincludes our connection to land, the ancestralknowledge connected to our indigenousfoods and our cultural languages, traditionsand lifeways.

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Vary Your Protein Foods

• Include beans and peas as a plant-based source of protein.• Choose seafood twice a week, such as salmon, tuna, or tilapia.• Enjoy hard-boiled eggs as a snack or with a meal.• Select leaner cuts of meat, such as round steaks and roasts or

skinless poultry.

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Make Half of Your Plate Fruits and Vegetables

• A simple way to eat more produce, is to make half your plate fruits andvegetables.

• For most people, this amounts to:• 1 to 2 cups of fruit per day and• 1 ½ to 3 cups of vegetables per day.

• Everyone’s nutrition needs are a little bit different. Our age, gender andactivity level are all factors that can influence how much of the differentfood groups we need to consume throughout the day.

• People who are more physically active have higher calorie needs, so theamounts of fruits and vegetables recommended may be even higher.

• For more information, visit https://www.choosemyplate.gov/.28

Antioxidants: Cancer Fighting, Cellular Support

• Antioxidants found in plant-based foods fight free radicals, whichare compounds in the body that attack and destroy cellmembranes. The uncontrolled activity of free radicals is believed tocause many cancers.

• What Do Antioxidants Do?• Antioxidants are nutrients in food that protect your cells from damage from

free radicals.• Free radicals are unstable molecules that can damage your cells. Your

body creates them when you digest food or breathe in pollution.• This cell damage may increase your risk of cancer, heart disease,

cataracts, diabetes, or infections. Free radicals may also affect brainfunction.

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Make Better Decisions About the Beverages You Drink

• MyPlate, along with the Nutrition Facts Label, can help youmake better food and beverage choices.

• The Nutrition Facts Label is located on most packaged foodsand beverages and provides helpful information, such as:

• The servings per container, which is the total number ofservings in the entire package or container.

• The serving size, which is a guide rather than arecommendation of how much to eat or drink.

• And calories per serving.

• Nutrition Facts labels have been around for many years, butthe U.S. Food and Drug Administration (FDA) recentlyupdated these labels.

• This slide shows a comparison of the original and new labels.Source: https://www.fda.gov/food/nutrition-education-resources-materials/health-educators-nutrition-toolkit-setting-table-healthy-eating

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Nutrition Facts and Nutrients• The Nutrition Fact label is full of helpful information on

different nutrients—both the ones to get more of and onesto get less of.

• Many Americans do not get the recommended amount offoods that provide the following nutrients: dietary fiber,vitamin D, calcium, and potassium.

• For young children, women capable of becoming pregnant,and women who are pregnant, a low intake of iron is also aconcern.

• To use the Nutrient Facts label to help you get more ofthese nutrients and compare and choose foods that have ahigher percent Daily Value (%DV).

• A DV of 5% or less per serving is considered low for thatnutrient; a DV of 20% or more is high.

Source: https://www.fda.gov/consumers/consumer-updates/nutrition-facts-label-reboot-tale-two-labels 31

Nutrition Facts: Saturated Fats, Trans Fats, Sodium, and Added Sugars

• We just discussed nutrients that positively affect our health.Now we will discuss the nutrients to get less of, whichincludes saturated fats, trans fat, sodium, and addedsugars.

• Healthy eating patterns limit these, which may help lowerthe risk of developing certain health conditions, such asheart disease.

• Compare the Nutrition Facts Label and choose foods with alower DV.

• (Note: Trans fat does not have a DV because there is norecommended amount. Keeping it as low as possible is agood goal.)

Source: U.S. Food and Drug Administration. Health Educator’s Nutrition Toolkit: Setting the Table for Healthful Eating. Available at: https://www.fda.gov/food/nutrition-education-resources-materials/health-educators-nutrition-toolkit-setting-table-healthy-eating

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Traditional Cooking Methods

• Lakota elders describe three common methods of cooking that were used:• Boiling, roasting, and baking.

• Frying has only become common since we had access to lard and oils for fryingand pans for frying.

• Traditional foods expert Wilmer Mesteth of Pine Ridge describes 13 differentway Lakota people preserved and prepared foods for use—none of theseinvolved frying.

• Not traditional:• Indian Tacos

• Bacon/Sausage

• Popovers

• Cake 33

Healthy Nutrition

• We are what we eat. It is important to introducehealthy eating and drinking to our children at birth,including breastfeeding.

• Almost 50% of all added sugars in the American dietare in drinks—like soft drinks, fruit drinks, and energydrinks.

• Shift to healthier beverage choices• There are two main types of sugar:

• Naturally occurring sugars such as those in milk or fruit

• Added sugars such as those added during processingsuch as fruit canned in heavy syrup or sugar added tocookies

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Food Distribution Program on Indian Reservations (FDPIR)

• FDPIR aims to provide low-income households with a healthy variety of foods to supplement their diets. It isdesigned as a more accessible alternative to SNAP

• FDPIR distributes a monthly food package. Participants can choose from a wide variety of nutritious foods,including fresh and canned fruits and vegetables, juices, cereals, grains (including whole-grain products), pasta,vegetable oil, meats, poultry, fish, and other proteins such as canned and dry beans, peanut butter, andpowdered egg mix.

• There have been many improvements in the types and variety of products offered in the food package.• Food insecurity is dramatically higher for FDPIR households than all households in the United States. In

2013, the percent of FDPIR households with low food security was more than four times the percent of U.S.households (34 percent compared to 8 percent).

• Fresh Produce Program and delivered weekly to ensure availability of fresh fruits and vegetables toparticipants throughout the month.

• Almost 90 percent of survey respondents indicated that they were satisfied with the food package – includingthe variety, freshness, quality, nutritional value, taste, and visual appeal of the food. Across sites visited, therewas a commonly held perspective that the quality of food in FDPIR has improved over time.

• Recommendations• Participant suggestions for improvements centered on building a more culturally relevant, local, and

fresh food package. The diversity across programs is perhaps most apparent in requests for cultural foods.Food items that are viewed as cultural vary considerably across Indian Country.

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NutritionFood is Medicine! Water is Life!• Protein

• The most important food source for the Lakota was the buffalo. Pte Oyate is the Lakota name forBuffalo Nation. Although buffalo was the primary food source, the Lakota hunted other animals aswell.

• Buffalo, elk, deer, rabbit, antelope

• Fruits & Veggies• Chokecherries, wild onion, dried corn, buffalo berries, wild strawberries, wild raspberries,

blueberries, mushrooms

• Grains & Starchy Veggies• Tinpsila (wild turnip), blo (wild potatoes), wild rice, beans

• Healthy Drinks• Water is the first medicine of the Lakota. Water sustains life. Every day the human body requires

half your weight in ounces of water to stay healthy and happy. Remember to drink plenty of water!

• Water, ceyaka (mint tea), sage tea, chokecherry juice 36

Eat a Variety of Nutritious Foods Every Day

• It’s important to eat a variety of nutritiousfoods every day in order to get thenutrients that are needed.

• Simple steps that can help are:• Including healthful foods from all food

groups.• Hydrating healthfully with beverages.• Learning how to read nutrition labels,

which you will learn how to do today.• Practicing portion control.• Taking the time to enjoy your food.

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Learn the Skills to Create Tasty Meals

Preparing food at home can be healthy, rewarding, and a great way to save money, too.

• Learn skills to create tasty meals. Things tokeep in mind include:

• Keeping healthful ingredients on hand.

• Practicing proper home food safety.

• Sharing meals together as a family whenpossible.

• Finding ways to reduce food waste.

• Trying new flavors and foods.

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Plan Your Meals Each Week• Plan your meals each week so that you can be

sure to include a variety of nutritious foods.

• Look in the refrigerator, freezer, and pantryfor foods that need to be used up.

• Write a list of the ingredients you still need.

• These steps can help you shop for healthfulfoods.

• Planning in advance will also help you:

• Be menu-savvy when dining out.

• Choose healthful recipes to make during the week.

• Enjoy healthful eating at school and at work.

• Eat healthfully while traveling.39

Honor the Role of Traditional Foods

• Honor the role of traditional foods in the holistichealth of Native people.

• Engage in active teaching methods, multi-sensorial.Ask patients to identify CHOs and other groups.

• Encourage including heritage CHOs: Corn, beans,squash, and whole potato as regular parts of meals.

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In Conclusion...

• Every little bit (or bite!) of nutrition is a step inthe right direction.

• Use credible sources for information.• Read your nutrition labels.Happy National Nutrition Month!

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Questions?

Kibbe Conti, MS, RDNZuni Comprehensive Community Health Center

[email protected]

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